Irregular periods in teens linked to health risks

Irregular periods in teens linked to health risks


By Genevra Pittman

NEW YORK (Reuters Health) - Teenagers who have irregular periods are more likely to be overweight and obese and to have early warning signs of diabetes and heart disease than those with regular menstrual cycles, suggests a new study.

While the link between irregular periods and heart disease and diabetes is well established in older women, the new finding suggests that doctors might be able to identify this risk much earlier -- and try to do something about it.

"There may be a misconception in adolescent medicine ... that 'it takes a couple of years after menarche to get the engine running' and hence one might not want to be concerned about irregular adolescent menstrual cycles until much later," said Dr. Charles Glueck, one of the study's authors from the Cholesterol and Metabolism Center at the Jewish Hospital of Cincinnati.

"That's clearly wrong."

Even in young teenagers, very irregular menstrual cycles are not normal, Glueck told Reuters Health, and shouldn't be ignored.

He and his colleagues followed 370 girls starting at age 14 as part of a larger study initiated by the National Heart, Lung, and Blood Institute.

Once every year, girls were asked how long it had been since their last menstrual cycle. Researchers also periodically measured their levels of different sex hormones, glucose and insulin (markers of diabetes risk) and blood pressure.

They also collected information on girls' height, weight, and waist circumference.

The authors das lasting more than 42 days -- that is, the girl's period begins more than 42 days after the first day of the last one -- a criterion that's meant to catch the 2 percent of girls with the least regular periods, Glueck explained.

Between age 14 and 19, 269 of the girls reported regular periods at every annual visit. Another 74 of them had only one report of an irregular period, 19 girls had two reports, and eight said it had been at least 42 days since their last period at three or more visits.

The results, published in Fertility and Sterility, show that girls with the most reports of irregular periods were already heavier than others at age 14, and gained more weight and inches on their waist during the study.

Also at age 14, girls with more irregular periods had higher levels of testosterone -- a sex hormone associated with male characteristics.

By age 25, those who hadn't reported an irregular period had an average body mass index, or BMI, of 26.8 -- considered slightly overweight. In comparison, participants who had reported irregular periods at three or more appointments had an average BMI of 37.8, indicating severe obesity. Girls who reported one or two irregular periods had BMIs somewhere in the middle.

Reports of irregular periods were also linked to higher levels of blood sugar and insulin at age 25.

The authors couldn't be sure what was happening with girls' menstrual cycles during the rest of each year. Also, the findings do not prove that irregular periods cause girls to gain weight or are responsible for the increases in glucose and insulin levels - rather, the irregularity could be a signal of some other problem.

One possibility is that the ovaries might respond to changes in metabolism -- such as increased insulin levels, said Dr. Alice Chang, an endocrinologist at UT Southwestern Medical Center. That would suggest some of the diabetes-related risks came before problems with ovulation.

What the study results do show is that irregular menstrual cycles might be a warning that the body's metabolism isn't working as well as it should.

"These relationships which we see so clearly in adolescence and see prospectively into young adulthood are the same relationships which two to three decades later spell out in the development of cardiovascular disease, (heart attack), and type II diabetes," Glueck said.

Irregular periods might be a sign of polycystic ovary syndrome, or PCOS -- a hormonal disorder that's also linked to infertility and obesity -- Glueck added. Catching it in adolescence means the condition can be "very successfully treated" -- another reason for doctors to pay attention to irregular periods early.

Chang, who was not involved in the new research, agreed that the implications for PCOS are an important message to take from the study.

"When I see women diagnosed with PCOS, they often have symptoms all throughout adolescence, but it's not put together for them," she told Reuters Health. "We need to be more aggressive in adolescents about treating PCOS and treating obesity."

Glueck said that girls with irregular menstrual cycles should "raise flags" for doctors, who can also step in with early prevention measures against diabetes, obesity, and heart disease.

SOURCE: http://bit.ly/lQEoNy Fertility and Sterility, online May 7, 2011.

Post-Partum Depression More Common in Abused Women Study in Hispanic women found domestic violence was even more predictive than history of depression

Post-Partum Depression More Common in Abused Women
Study in Hispanic women found domestic violence was even more predictive than history of depression

By Robert Preidt

(HealthDay News) -- Hispanic women who suffer domestic abuse during or shortly before becoming pregnant have a fivefold increased risk of postpartum depression, U.S. researchers say.

The findings suggest that intimate partner violence is a stronger predictor of postpartum depression than prenatal depression, which is generally regarded as the most significant risk factor.

The study of 210 Hispanic women aged 18 and older in Los Angeles found that women who experienced domestic violence during pregnancy or within the 12 months prior to pregnancy were 5.4 times more likely to suffer postpartum depression than those who hadn't suffered recent abuse.

The researchers also found that women who experienced prenatal depression were 3.5 times more likely to have postpartum depression than those who didn't experience prenatal depression.

These findings indicate that pregnant women should be screened for both prenatal depression and intimate partner violence, said the researchers at the University of California, Los Angeles Center for Culture, Trauma and Mental Health Disparities.

The study appears in the current issue of the Archives of Women's Mental Health.

SOURCE: University of California, Los Angeles, Health Sciences, news release, May 2011

Study Suggests Supplement May Protect Against Preeclampsia Others warn of possible side effects and urge more research before pregnant women try it

Study Suggests Supplement May Protect Against Preeclampsia
Others warn of possible side effects and urge more research before pregnant women try it

By Randy Dotinga
(HealthDay News) -- Though a new study suggests that a dietary supplement could lower the likelihood that high-risk pregnant women will develop preeclampsia, the jury is still out over whether it actually works and a specialist recommends that women not try it yet.

Preeclampsia is a pregnancy complication that can boost blood pressure to abnormally high levels, causing hypertension. It affects about 5 percent of first pregnancies.

"Women die of uncontrolled hypertension through stroke or multi-organ failure," said Dr. David Williams, an obstetrician and consultant in maternal medicine at University College London Hospitals, who co-wrote a commentary accompanying the study, which was published online May 19 in BMJ.

"Comprehensive prenatal care and modern medical practice in developed countries makes maternal mortality from preeclampsia a rare event, but it accounts for 20 percent of maternal mortality in many developing countries," Williams explained.

Scientists suspect that low levels of an amino acid called L-arginine could play a role in the development of the disease, and some have wondered whether antioxidant vitamins could lower the risk of the condition.

For the study, researchers in Mexico assigned high-risk pregnant women to one of three groups: 228 ate food bars containing L-arginine and antioxidant vitamins; 222 ate bars with vitamins only; and 222 ate bars that didn't contain the amino acid or the vitamins, considered the placebo group.

After eating the food bars daily from 20 weeks into their pregnancy through delivery, only 13 percent of the women who ate bars with L-arginine plus antioxidants developed preeclampsia; they also were less likely to give birth prematurely. In the vitamins-only group, 23 percent developed preeclampsia, as did 30 percent of women in the placebo group.

"This relatively simple and low-cost intervention may have value in reducing the risk of preeclampsia and associated preterm birth," the study concluded.

But the authors of the accompanying commentary raise questions about possible harmful effects and suggest there needs to be more research to understand "the numerous inconsistent strands of evidence relating to L-arginine and its possible effects on preeclampsia."

Williams said: "We still do not understand the complex, interacting ways in which preeclampsia develops, and it is likely to be different in different women. More work needs to be done to understand the potential of L-arginine with antioxidant vitamins, and at this stage, we do not recommend that this supplementation should be given to women at risk of preeclampsia."

SOURCES: David Williams, M.D., consultant in maternal medicine, University College London Hospitals, London; BMJ, news release, May 19, 2011

Parent's Fears Deprive Some Asthmatics of Flu Shot: Study Those who shun shots also less likely to know that flu can trigger breathing ills, survey finds

Parent's Fears Deprive Some Asthmatics of Flu Shot: Study
Those who shun shots also less likely to know that flu can trigger breathing ills, survey finds

By Robert Preidt

(HealthDay News) -- Concern about vaccine safety is one of the main reasons why some parents in the United States are reluctant to have their asthmatic children vaccinated against the flu, researchers report.

The new study also found that parents who don't vaccinate their asthmatic children are less likely to consider flu to be a trigger for their child's asthma.

Flu vaccination is recommended for all children, but especially for those with asthma because flu can trigger asthma flare-ups.

The study included 237 parents who had at least one child with asthma and took part in a national survey conducted in the summer of 2010.

Seventy percent of the parents said they had their child vaccinated against seasonal or H1N1 influenza during the 2009-2010 flu season, and 65 percent said they planned to have their child vaccinated in the 2010-2011 flu season.

Parents who didn't vaccinate their children were less likely than those who did vaccinate to believe that getting the flu was a "very important" asthma trigger (53 percent vs. 72 percent), and more likely to be concerned that the vaccine would cause side effects (60 percent vs. 26 percent) or make their child sick (41 percent vs. 13 percent).

The study was scheduled for presentation May 16 at the American Thoracic Society's international conference in Denver.

"Not surprisingly, parents who felt that their children were likely to experience an asthma attack when they got a respiratory infection were more likely to get their child vaccinated," study author Dr. Toby Lewis, an assistant professor of pediatric pulmonology at C.S. Mott Children's Hospital in Ann Arbor, Mich., said in a society news release.

"Worries about potential side effects of the vaccine emerged as an important factor for families who did not have their child vaccinated. The group as a whole indicated that their physician was an important source of health information for their family, suggesting that physicians may have an opportunity to advise families about this important preventative measure," Lewis added.

"The results will help physicians, public health professionals and health educators tailor messages most effectively to this group of families," Lewis concluded.

SOURCE: American Thoracic Society, news release, May 16, 2011

Kids of Deployed Parents May Face Mental Health Risks Study found 10% higher chance of hospitalization for psychiatric problems in 9- to 17-year-olds

Kids of Deployed Parents May Face Mental Health Risks
Study found 10% higher chance of hospitalization for psychiatric problems in 9- to 17-year-olds

(HealthDay News) -- Children whose parents are deployed in Afghanistan or Iraq face a higher risk of psychiatric problems requiring hospitalization, a new study indicates.

Researchers from the Uniformed Services University of the Health Sciences tracked over 375,000 children, aged 9 to 17, whose parents were on active duty between 2007 and 2009.

"There was a 10 percent increased risk of hospitalization among children 9 to 17 whose parents were deployed," said Dr. Jeffrey Millegan, disaster and preventive psychiatry fellow at the Uniformed Services University of the Health Sciences.

He presented the finding this week at the American Psychiatric Association's annual meeting in Honolulu.

In all, the investigators found that 2,533 children in the study were hospitalized for a mental or behavioral health problem, staying a median of eight days.

Of that, about one-third, or 858 children, had parents who were deployed during the study period.

After taking into account factors such as past history of psychiatric problems, Millegan arrived at the 10 percent increased risk. When he looked at the parents' length of deployment, he found the link only held up when the parent was gone longer than six months.

More attention needs to be paid to the mental health of children of active duty military parents when they are deployed, the researchers said.

What can parents do to lessen the impact? While resilience research is still in its infancy, Millegan suggested that family doctors should ask parents about to be deployed how their children are doing.

Parents and others who are aware of the risk, he said, may better catch mental health problems when they are less serious than those needing hospitalization.

The study was deemed novel by Dr. Jeffrey Borenstein, chair of the American Psychiatric Association's Council on Communications, who moderated the Monday news conference announcing the findings.

"There really hasn't been this kind of research up until now on the effect on the children," he said. Previous research has linked a parent's deployment to war with increased anxiety and behavioral problems in their children.

Borenstein said the finding about length of deployment having an effect on the child's mental health was of particular interest. With further research, he said, the number of times a parent is deployed would likely be found to have an effect, too.

For now, he said, the research can help inform those involved and alert them to try to minimize the risk.

Millegan also found that children with a past history of mental health problems were more likely to have them again. The civilian parent's past psychiatric history also affected the child's risk of hospitalization for mental health problems.

The increased mental health problems, Millegan said, are likely related to the obvious family disruption that occurs when a major caregiver leaves for a period of time.

Other research has found that mental health issues can affect both the deployed parent and the parent who stays home, suggesting there could be a trickle-down effect. "It's quite clear that [the mental health issues faced by the parents] can have an influence on the children," he said.

Because this study was presented at a medical meeting, the data should be viewed as preliminary until published in a peer-reviewed journal.

SOURCES: Jeffrey Millegan, M.D., M.P.H., disaster and preventive psychiatry fellow, Uniformed Services University of the Health Sciences, Bethesda, Md.; Jeffrey Borenstein, M.D., chair, Council on Communications, American Psychiatric Association; May 16, 2011, presentation, American Psychiatric Association annual meeting, Honolulu

Sphincter of Oddi Dysfunction

Sphincter of Oddi Dysfunction

By: Peter B. Cotton, MD, Professor of Medicine, Digestive Disease Center, Medical University of South Carolina, Charleston, SC

The sphincter of Oddi is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through ducts from the liver and pancreas (the Ampulla of Vater) into the first part of the small intestine (duodenum). “Sphincter of Oddi dysfunction (SOD)” describes the situation when the sphincter does not relax at the appropriate time (due to scarring or spasm). The back-up of juices causes episodes of severe abdominal pain. The diagnosis is often considered in patients who present with recurrent attacks of pain after surgical removal of the gall bladder (cholecystectomy), and in some who suffer from recurrent attacks of unexplained pancreatitis. More than half a million cholecystectomies are performed annually in the United States, and 10–20% of these patients present afterwards with continuing or recurrent pains.

About half of these patients will have some impressive objective findings on laboratory studies or imaging (e.g. abnormal liver enzymes on blood testing, or a dilated bile duct on an Ultrasound or CT scan), to suggest definite pathology, such as a stone in the bile duct. These patients are categorized by the Milwaukee classification as SOD Types I and II. MRCP (magnetic resonance cholangio-pancreatography) is nowadays a good non-invasive test for checking on the biliary and pancreatic drainage systems.

When symptoms are severe, and the laboratory and scanning findings are impressive, standard treatment is to perform an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP). This is done under sedation by experts trained in the technique. They pass an instrument (under sedation or anesthesia) down to the duodenum, where the bile duct and pancreatic ducts drain. They inject dye through the Ampulla of Vater into the ducts, and treat what is found, usually by cutting the muscular sphincter (sphincterotomy) to remove any stones or to relieve any scarring or spasm of the sphincter.

Patients with a similar pain problem, but who have little or no abnormalities on blood tests and standard scans (including MRCP), are categorized as SOD type III, with the supposition that episodes of pain are due to intermittent spasm of the sphincter. These patients are very difficult to evaluate and to manage effectively. Indeed some physicians are skeptical of its existence of SOD III, or assume that it is only a small part of a broader problem of a functional digestive disturbance such as irritable bowel syndrome.

A very important problem in this context is that these ERCP procedures carry a significant risk of complications. In particular, ERCP (with or without SOM) can cause an attack of pancreatitis in 5–10% of cases. Whilst most of these result in only a few days in hospital, about 1% of patients suffer a major attack, with weeks or months in hospital. Sphincterotomy also carries a small risk of other severe complications such as bleeding and perforation, and the possibility of delayed stenosis due to scarring.

Because of the risks of ERCP, patients with suspected SOD III are usually advised to try medical treatments first. Some respond to the use of anti-spasmodic drugs and/or anti-depressants that modulate the pain pathways. There have been trials of other medical therapies, such as calcium channel blocking drugs. Despite a few encouraging reports, these modalities have not proven to be effective generally, and are not widely used.

Patients who fail these approaches (at least those with severe symptoms) are usually sent to specialists at tertiary referral centers for further evaluation. This may involve an Endoscopic Ultrasound study to look for minor changes in the pancreas, and MRCP (if not already performed). If nothing else is found, ERCP is recommended to check that there are no subtle structural abnormalities in the papilla, biliary tree or pancreas, and to allow measurement of the actual pressure in the sphincter, by performance of Sphincter of Oddi manometry (SOM). The results of SOM are used to decide whether to perform treatment (at the same ERCP examination), by sphincterotomy of the biliary and/or pancreatic sphincters. SOM is not widely available, and the results are not consistently predictive of the outcome of treatment. In general it appears that biliary sphincterotomy provides benefit in 70% of these patients, at most.
Clinical Study

These uncertainties in how best to diagnose and to treat “suspected sphincter of Oddi dysfunction” (and the risks involved) mandate further scientific investigation. The National Institutes of Health has recently funded an important study called “EPISOD” in 6 major Gastroenterology centers in USA.

Essentially, patients with burdensome pains after cholecystectomy who fulfill the Rome III criteria for sphincter of Oddi dysfunction undergo extensive evaluation for functional and psychiatric disorders. If they consent to the study, they undergo ERCP with SOM, and are randomized to biliary and/or pancreatic sphincterotomy, or to a sham procedure, regardless of the manometry findings. Their clinical course is monitored for up to 4 years. The studies are being conducted at centers located in:
Baltimore, MD
Birmingham, AL
Charleston, SC
Indianapolis, IN
Minneapolis, MN
Seatle, WA

Additional details are available at the NIH website at www.clintrials.gov.
Update: Sphincter of Oddi dysfunction research study needs patients

We have an NIDDK-funded randomized sham-controlled study designed to see which (if any) patients with “Sphincter of Oddi Dysfunction III” respond to sphincter ablation, and which clinical and manometry factors predict the outcome.

The study is progressing well with 70 subjects randomized (the largest number ever in a randomized trial in SOD), but we need 214. So, this is a request to consider referring suitable subjects to one of the 7 active sites.

The basic eligibility criteria are: disabling post-cholecystectomy pain, aged 18-65, no prior pancreatitis or previous sphincter treatment, normal anatomy, normal EGD and scans (bile duct <9mm), failed treatment with PPIs and antispasmodics, liver tests and amylase/lipase <2-3X normal, no daily narcotics, not suicidal.

After informed consent and detailed clinical documentation, subjects undergo ERCP with biliary and pancreatic manometry. They are then randomized to sphincterotomy or sham (2:1 sphincterotomy versus sham). regardless of the manometry results. Those patients randomized to the sphincterotomy arm and who have raised pancreatic sphincter pressures are randomized again to biliary or to biliary and pancreatic sphincterotomy. All subjects get a small temporary pancreatic stent. Patients, caregivers, and research coordinators are blinded to the treatment allocation. Success is defined by substantial reduction in pain burden at 1 year (without any repeat intervention).

Details of the protocol and site contacts are available at www.clinicaltrials.gov. Thank you.
Peter B Cotton
Professor of Medicine, Digestive Disease Center, Medical University of South Carolina, Charleston.